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APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (Instructions on reverse side) p~Ge oNe oF P~~~S Courthouse Square APPLICATIO:~ NO.: 9900600001 Distribution to: TO OWNER: M~on Co. & SalemArea Transit PROJECT: 3/31/99 PERIOD TO: ^ OWNER Attn: John WhittinSton 99-006 ARCHITECT 3140 Del Webb Ave NE PROJECT tiOS.: ~ ^ CONTRACTOR Salem, OR 97303-4165 2/17/99 pence/Kelly Construction, Inc. VIA ARCHITECT: ~~uckle Costic Architects CONTRACT DATE: ~ FROM COtiTR~,CTOR: 363 State Street ~ PO Box 4109 Salem, OR 97302-8109 Salem, OR 97301-3533 CONTRACT FOR: The undersigned Contractor certifies that ro the best of the Contracro['s knowledge, infor- CONTRACTOR'S APPLICATION FOR PAYMENT mation and belief the Work covered by chis Applica~ion for Payment has been compleced Applicacion is made for payfnenc, as shown below, in connection with the Contract. Conit~ tor for Wo ktfor which prev~ous1Certificateslfor Paymenhwerb issuPdlandypa e Continuation Sheet, AIA Documen[ G?03, is attached. 18,459,484.00 ments received from t wner, and that currenc paymenc shown herein is now due. 1 ORIGINAL CONTRACT SUM . . . . . . . . . . . . . . . . . ~ - 0.00 CON OR: 2 . Net change by Change Orders . . . . . . . . . . . . . • • S '` 18,459,484.00 By: Date: 3 . CONTRACT SUM TO DATE (Line 1 t 2) . . • . . • • • ~ 114,529.00 State of: d~so r` 4. TOTAL COMPLETED & STORED TO DATE ......~ County of: f7lar;o~ (Column G on G?03) Subscribed and sworn to before ; RETAI~~GE: 5,726.00 me this lS+ day of ~~~ ~ 99 a. % of Completed Work ~ (Columns D + E on G,03) 0.00 b, ~•~Q% of Srored L4arerial ~ (Column F on G^03) Tota! Recainage (Line 5a + 5b or ~ 5,726.00 To[al in Column t of G-03) .. 108,803.00 6 TOTAL EARNED LESS RETAINAGE . . . . . . . . . . . . 3 (Line =~ less Line ~ To~al) ~ LESS PREVIOUS CERTIFICATES FOR PAYMENT ~ (Line 6 from prior Certificate) ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ g 108,803.00 £~ CURRENT PAYMENT DUE . . . . . . . . . . . . . . . ~' 9 BALANCE TO FINISH, INCLUDING RETAI~NAGFlg 350,681.00 (Line 3 less Line 6) CHANGE ORDER SliMMARY ADDITIONS DEDUCTIONS Tocal changes appro~~ed in , previous months b~~ OR~ner i Total approved this Month TOTALS I ~ET CHANGES b~~ Change Order 0.00 ~ /_ Notary Public: Mv Commission expires: ~ - (~- Z~ ~ ..~, ~~ OFFICIAL SEAL ~r1TTHEW L SMITH ~ ~, ~du~iARY PUBLIC - OREGOP! COMMISSION N0. 303013 ~ ~4Y COMN~fSSION ~XP!RES JULY 14, 2001 ~ ~- ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance wi[h che Concracc Documents, based on on-site observacions and the data comprising this application, the Archirect certifies to the Owner that ro the best of the Architect's knowledge, information and belief the Work has progressed as indicated, ~he quality of the Work is in accordance with the Contract Documencs, and the Con~racro: is encitled to payment of che AMOUNT CERTIFIED. AMOUNT CERTIFIED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 ~ ~~3. °!Q (Attach explanation :f amount certified difJers from the amount applied for. Initial all figures on this App cation and on tbe Continuation Sheet that are changed to conform to the amo t c tified.) ARCHITE By Date: This reis noc negotiable. The AMOL'NT CERTIFIED is payable only ~o che Con tractor named herein. Issuance, payment and acceptance of payment are withouc prejudice to an}~ rights of the Owner or Concraccor under chis Contrac~. - ',35 "EVC- ~~oR ~ G702-1992 AIA DOCUMENT G7D2 •.~PPLICATIO^7 AND CERTIFICATE FOR PAYMENT • 1992 EDITiON • AIA~ • ~O1992 • THE ~ ~ aN 1~~~5g~b~~ ~e ~R IatorEto ley I pros,ecution. , „ At~E'~L'E. v~~' ~~'~~HItiGTO~, DC ~~~~~5~~, • WARNING: Ilcensed photocopying violetes U.S. cp ~~ ~~~ ~~~r~ ~ ~~~P/h~ ~ ~ ~ _ , ' ~ :.!;;. I~ `~ ~ ~ ~. ~, _,..~, ~~ n.+..~,~..+~.,+ whlrh hhc~IR CAII•IOf1 DfI 4_ red. A origlnal assures t~iat changes will not be obscuratl a,9 may occur when documents are reproduced.